New York Doctors Initial Report is a document created by physicians in New York State that is used to provide an initial assessment of a patient's medical condition. It contains a summary of the patient's medical history, a physical examination, a diagnosis, and a treatment plan. It is used by healthcare providers to document the initial visit and to guide future care. There are two types of New York Doctors Initial Report: the written report and the electronic report. The written report is a paper document that is completed by the physician and signed by the patient. The electronic report is an electronic form that is completed by the physician and the patient and then submitted electronically. Both reports require the patient's consent in order to be completed.
New York Doctors Initial Report
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FAQ
C4: Closed, entitled to COP.
The Employees Claim for Compensation is filled out by both you and an examining workers' compensation doctor. This must be done within 90 days of the injury.
Employers must report to NVOSHA all workplace accidents involving an employee fatality or fatalities within 8 hours after learning of the accident.
Filing A Workers' Compensation Claim The C-4 form is titled ?Employee's Claim for Compensation/Report of Initial Treatment?. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.
A rating of 100 percent means that you have a permanent total disability.
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT. FORM C-4.
SI-12 (7/09) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license or contract. The SI-12 must be completed by the Board's Self-Insurance Office and approved by the Board's Secretary.
Form C-43: Revocation of Written Authorization.